Blue Shield 65 Plus (HMO)
Blue Shield of California · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $2,300
- Higher than most plans here
- Drug deductible
- $425
- Higher than most plans here
- Medicare star rating
- 4 of 5
In plain English
Compared with the 19 other plans in Kern County that the same person could join.
What stands out
- No monthly premium
Watch out for
- Up to $2,300 a year for covered care, higher than most plans here
- $1,000 for a 5-day hospital stay, higher than most plans here
- $425 drug deductible, higher than most plans here
- No dental extra, though most plans here have one
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$0$0 in premiums + $0 for careTied for lowest here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$1,615$0 in premiums + $1,615 for careHigher than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$0Referral needed
- Urgent care$0
- Emergency room$150Not charged if you stay in the hospital within 1 days
- Hospital stay$200 a day for days 1 to 5, then $0 for days 6 to 90Higher than most plans hereReferral neededPlan approval may be needed
- Lab tests$0Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$50Higher than most plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$200Tied for highest here
- X-rays$0Referral needed
- MRI, CT and other scans$70Highest of 7 plans hereReferral needed
- Ground ambulance$325Higher than most plans herePlan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $125 a day for days 21 to 100Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 19 other plans in Kern County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Preferred Generic | $0 | $5 |
| 2Generic | $5 | $12 |
| 3Preferred BrandAfter the deductible | 25% of the price | 25% of the price |
| 4Non-Preferred DrugAfter the deductible | 30% of the price | 30% of the price |
| 5Specialty TierAfter the deductible | 28% of the price | 28% of the price |
For a 1-month supply. The $425 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental Not included
- Vision IncludedYearly eye exam: $10. Glasses or contacts covered.Eyewear has a limit; ask the plan.
- Hearing Not included
- Over-the-counter items IncludedUp to $60 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Not included
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Blue Shield 65 Plus (HMO), plan number H0504-038, for 2026?”